Proficiency-based virtual reality training significantly reduces the error rate for residents during their first 10 laparoscopic cholecystectomies

Åhlberg, Gabrielle; Enochsson, Lars; Gallagher, Anthony G.; Hedman, Leif; Hogman, Christian; McClusky, David A.; Ramel, Stig; Smith, C. Daniel; Arvidsson, Dag

doi:10.1016/j.amjsurg.2006.06.050

Cited by 575 publications

(443 citation statements)

References 18 publications

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“…Several studies showed that virtual reality simulators when compared to no supplementary training improve surgical performance [5,3,19,20]. The VR group in the current study demonstrated improvement in surgical performance after practicing on a virtual reality simulator in regards to time taken to perform the simulated procedure.…”

Section: A C C E P T E D Accepted Manuscriptsupporting

confidence: 51%

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“Take-home” box trainers are an effective alternative to virtual reality simulators

Yiasemidou

Siqueira

Tomlinson

et al. 2017

Journal of Surgical Research

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Background: Practice on Virtual Reality simulators (VRS) have been shown to improve surgical performance. However, VRS are expensive and usually housed in surgical skills centres that may be inaccessible at times convenient for surgical trainees to practice. Conversely, box trainers are inexpensive and can be used anywhere at anytime. This study assesses "take-home" Box Trainers (BT) as an alternative to VRS.Methods: After baseline assessments (two simulated laparoscopic cholecystectomies, one on a VRS and one on a BT) 25 surgical trainees were randomised to two groups. Trainees were asked to practice 3 basic laparoscopic tasks for 6 weeks (BT group using a "take-home" box trainer; VR group using VRS in clinical skills centres). After the practice period all performed two LC, one on a VRS and one on a BT; (i.e. post-training assessment). VRS provided metrics (total time (TT), number of movements (NOM) instrument tip path length (PL)) and expert video assessment of cholecystectomy in a BT (GOALS score) were recorded. Performance during pre-and post-training assessment was compared.Results: The BT group showed a significant improvement for all VRS metrics (p=0.008) and the efficiency category of GOALS score (p=0.03). Only TT improved in the VRS group and none of the GOALS categories demonstrated a statistically significant improvement after training.

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Section: A C C E P T E D Accepted Manuscriptsupporting

confidence: 51%

“…Unfortunately, this is a rather frequent occurrence in educational studies [20,3,19,35,2]. Assessing the clinical impact of the study is methodologically challenging, as a number of participants did not have the opportunity to perform real laparoscopic cholecystectomies immediately after the completion of the study.…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

“Take-home” box trainers are an effective alternative to virtual reality simulators

Yiasemidou

Siqueira

Tomlinson

et al. 2017

Journal of Surgical Research

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“…The incorporation of VR simulators in training regimes offers the potential to reduce error rate which, as well as improving patient outcomes and satisfaction, will also reduce fiscal burden by decreasing the risk of litigation. Seymour et al (2002) showed skills transfer from training on a simulator to the operating theater, and this has been emulated by other studies (Ahlberg et al 2007, Verdaasdonk et al 2008, Larsen et al 2009) including 1 with an orthopedic arthroscopic simulator (Howells et al 2008). Other factors to consider include gender differences, hand dominance, and age correlated with objective scoring.…”

Section: Discussionmentioning

confidence: 86%

Training effect of a virtual reality haptics-enabled dynamic hip screw simulator

et al. 2015

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Background and purpose — Virtual reality (VR) simulation offers a safe, controlled, and effective environment to complement training but requires extensive validation before it can be implemented within the curriculum. The main objective was to assess whether VR dynamic hip screw (DHS) simulation has a training effect to improve objective performance metrics.Patients and methods — 52 surgical trainees who were naïve to DHS procedures were randomized to 2 groups: the training group, which had 5 attempts, and the control group, which had only one attempt. After 1 week, both cohorts repeated the same number of attempts. Objective performance metrics included total procedural time (sec), fluoroscopy time (sec), number of radiographs (n), tip-apex distance (TAD; mm), attempts at guide-wire insertion (n), and probability of cut-out (%). Mean scores (with SD) and learning curves were calculated. Significance was set as p < 0.05.Results — The training group was 68% quicker than the control group, used 75% less fluoroscopy, took 66% fewer radiographs, had 82% less retries at guide-wire insertion, achieved a reduced TAD (by 41%), had lower probability of cut-out (by 85%), and obtained an increased global score (by 63%). All these results were statistically significant (p < 0.001). The participants agreed that the simulator provided a realistic learning environment, they stated that they had enjoyed using the simulator, and they recognized the need for the simulator in formal training.Interpretation — We found a significant training effect on the VR DHS simulator in improving objective performance metrics of naïve surgical trainees. Patient safety, an important priority, was not compromised.

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“…2A-B Built-in motion analysis metrics from the virtual simulator were able to distinguish novice and proficient arthroscopists by overall scores and economy of motion, but not in care with soft tissues. The novice group had lower overall scores in the virtual scope (3 ± 2 [95% CI, 2-4] versus 5 ± 3 [95% CI, [3][4][5][6][7][8], p = 0.018), virtual probe (5 ± 2 [95% CI, 3-6] versus 7 ± 1 [95% CI, 6-8], p = 0.009), and virtual loose-body tasks (4 ± 1 [95% CI, 3-5] versus 6 ± 1 [95% CI, [5][6][7], p = 0.001) (Fig. 3A-B Performance on virtual and benchtop models showed strong correlation based on subjective GRS scores and objective motion analysis metrics, suggesting that subjects performed similarly on both models.…”

Section: Resultsmentioning

confidence: 99%

“…Future work should compare different modalities in the efficiency of skill acquisition, retention, and transferability to the operating room. Ultimately, as previously attempted in general surgery [4,7,17,26,30], patient safety may be improved by determining predefined levels of competence on simulated modalities. Such a measure would allow safe and measurable transition of residents from practicing in the laboratory to performing on patients in the operating room.…”

Section: Discussionmentioning

confidence: 99%

Global Rating Scales and Motion Analysis Are Valid Proficiency Metrics in Virtual and Benchtop Knee Arthroscopy Simulators

Chang

Banaszek

Gambrel

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Work-hour restrictions and fatigue management strategies in surgical training programs continue to evolve in an effort to improve the learning environment and promote safer patient care. In response, training programs must reevaluate how various teaching modalities such as simulation can augment the development of surgical competence in trainees. For surgical simulators to be most useful, it is important to determine whether surgical proficiency can be reliably differentiated using them. To our knowledge, performance on both virtual and benchtop arthroscopy simulators has not been concurrently assessed in the same subjects. Questions/purposes (1) Do global rating scales and procedure time differentiate arthroscopic expertise in virtual and benchtop knee models? (2) Can commercially available built-in motion analysis metrics differentiate arthroscopic expertise? (3) How well are performance measures on virtual and benchtop simulators correlated? (4) Are these metrics sensitive enough to differentiate by year of training? Methods A cross-sectional study of 19 subjects (four medical students, 12 residents, and three staff) were recruited and divided into 11 novice arthroscopists (student to Postgraduate Year [PGY] 3) and eight proficient arthroscopists (PGY 4 to staff) who completed a diagnostic arthroscopy and loose-body retrieval in both virtual and benchtop knee models. Global rating scales (GRS), procedure times, and motion analysis metrics were used to evaluate performance. CI, seconds, p = 0.002). The built-in motion analysis metrics also distinguished novices from proficient arthroscopists using the self-generated virtual loose body retrieval task scores (4 ± 1 [95% CI, 3-5] versus 6 ± 1 [95% CI, 5-7], p = 0.001). GRS scores between virtual and benchtop models were very strongly correlated (q = 0.93, p \ 0.001). There was strong correlation between year of training and virtual GRS (q = 0.8, p \ 0.001) and benchtop GRS (q = 0.87, p \ 0.001) scores. Conclusions To our knowledge, this is the first study to evaluate performance on both virtual and benchtop knee simulators. We have shown that subjective GRS scores and objective motion analysis metrics and procedure time are valid measures to distinguish arthroscopic skill on both virtual and benchtop modalities. Performance on both modalities is well correlated. We believe that training on artificial models allows acquisition of skills in a safe environment. Future work should compare different modalities in the efficiency of skill acquisition, retention, and transferability to the operating room.123 Clin Orthop Relat Res (2016) 474:956-964 DOI 10.1007/s11999-015-4510-8 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® GRS scales. The proficient subjects completed nearly all tasks faster

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Proficiency-based virtual reality training significantly reduces the error rate for residents during their first 10 laparoscopic cholecystectomies

Cited by 575 publications

References 18 publications

“Take-home” box trainers are an effective alternative to virtual reality simulators

“Take-home” box trainers are an effective alternative to virtual reality simulators

Training effect of a virtual reality haptics-enabled dynamic hip screw simulator

Global Rating Scales and Motion Analysis Are Valid Proficiency Metrics in Virtual and Benchtop Knee Arthroscopy Simulators

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